Improved Balance, Gait, and Lower Limb Motor Function in a 58-Year-Old Man with Right Hemiplegic Traumatic Brain Injury Following Virtual Reality-Based Real-Time Feedback Physical Therapy.

BACKGROUND This report presents the case of a 58-year-old man with right hemiplegia who improved his gait and lower limb motor function following virtual reality (VR)-based physical therapy. The use of augmented reality or VR-based technology is being increasingly used to support physical therapy in patients with motor deficits and to improve gait, and can be used in small hospitals and outpatient departments. CASE REPORT A 58-year-old man was diagnosed with left hemiplegia due to traumatic brain injury (TBI). He received 20 minutes of VR-based real-time feedback gait training and 30 minutes of general physical therapy, 5 times a week for 8 weeks. BioRescue was used for measurement of balance, GAITRite was used for measurement of gait, and Fugl-Meyer assessment was used for lower extremity motor function measurement. These were measured before the intervention and at 2, 4, 6, and 8 weeks after the intervention. After the intervention, center of pressure and limits of stability also increased. The affected step length, stride length, affected single support, and cadence were significantly increased after VR-based real-time feedback. Additionally, his lower extremity motor function score increased from 18 to 23 points. CONCLUSIONS This case report supports recent studies that have shown the value of VR-based methods as part of a physical therapy program in patients with problems with gait and motor function, including patients with stroke. VR-based real-time feedback showed favorable effects on rehabilitation following a TBI.

Effects of Maitland Thoracic Joint Mobilization and Lumbar Stabilization Exercise on Diaphragm Thickness and Respiratory Function in Patients with a History of COVID-19.

Objective: We investigated the effects of maitland thoracic joint mobilization and lumbar stabilization exercise on diaphragm thickness and respiratory function in patients with a history of COVID-19. Methods: Thirty patients who had passed one month after COVID-19 onset were randomly divided into maitland thoracic mobilization and lumbar stabilization and combined breathing exercise groups; each group performed thoracic mobilization and lumbar stabilization exercises and combined breathing exercise and ergometer exercises, respectively, for 50 min, three times a week, for eight weeks. We used the MYSONO U5 MicroQuark to evaluate diaphragm thickness and respiratory function (forced vital capacity, forced expiratory volume in the one second, peak expiratory flow), respectively. Results: There were no significant between-group differences in general patient characteristics and change in diaphragm thickness and respiratory function. Both groups showed significant improvement within each parameter. However, the maitland thoracic mobilization and lumbar stabilization group showed more significant improvements than did the combined breathing exercise group (p < 0.05). Conclusion: In this study, we confirmed the maitland thoracic joint mobilization and lumbar stabilization exercise on the diaphragm thickness and respiratory function in patients with a history of COVID-19.

Effects of ankle joint proprioceptive training and thermal approach on stroke patients' trunk, balance stability and gait parameter.

BACKGROUND: Numerous studies have investigated factors for trunk, balance stability and gait parameters of post-stroke patients. Evidence-based recommendations are required for the treatment of ankle proprioceptive exercise with thermal stimulation in post-stroke patients. OBJECTIVE: We investigated the effects of ankle proprioceptive exercise with thermal stimulation on the trunk stability, balance, and gait ability of post-stroke patients. METHODS: A total of 30 patients were randomly divided into the ankle proprioceptive training and thermal stimulation group (APT) and control group. The APT group performed ankle proprioceptive exercises with thermal stimulation for 60 min five times a week for eight weeks. The control group followed conservative treatment for 60 min five times a week for eight weeks. Trunk stability was measured with the trunk impairment scale (TIS) and balance tests were performed with the center of pressure (COP), limits of stability (LOS), Berg Balance Scale (BBS), and functional reach test (FRT) and gait ability was performed by OptoGait and 10 m WT. RESULTS: There was a significant difference (p< 0.05) between before and after training in both groups. The APT group showed significant improvement in both groups. CONCLUSION: This study can be used as intervention data for recovering trunk, balance stability and gait parameters in post-stroke patients.

Effects of Task-Specific Training after Cognitive Sensorimotor Exercise on Proprioception, Spasticity, and Gait Speed in Stroke Patients: A Randomized Controlled Study.

Background and objectives: Common problems in stroke patients include loss of proprioception, spasticity, and impaired gait. The purpose of this study was to examine the effects of task-specific training (TST) combined with cognitive sensorimotor exercise (CSE) on proprioception, spasticity and gait speed in stroke patients. Materials andMethods: Thirty-seven subjects were randomly divided into three groups; (1) the TST after CSE group (Experimental I, n = 13); (2) the TST group (Experimental II, n = 12), and (3) a conventional physical therapy training group (control group, n = 12). Evaluations were performed before the commencement of training and again eight weeks after training was initiated. An electrogoniometer was used to evaluate proprioception variation. The composite spasticity score (CSS) and MyotonePRO were used to evaluate spasticity. In addition, 10 m walk test was used to assess gait speed. Results: After training, the Experimental I group showed significant improvement in proprioception compared to the Experimental II and control group (p < 0.05). In CSS, gastrocnemius muscle tone (GMT) and gait speed among three groups, Experimental I group differed significantly after eight weeks of training compared to the control group (p < 0.05). Conclusions: These findings suggest that the TST combined with CSE provided significant improvements in proprioception, spasticity, and gait speed.

Effects of Cognitive Sensory Motor Training on Lower Extremity Muscle Strength and Balance in Post Stroke Patients: A Randomized Controlled Study.

BACKGROUND: Sensory motor impairment, the most common neuromuscular condition in stroke patients, often contributes to muscle weakness and imbalance. OBJECTIVE: The purpose of this research was to investigate the effects of cognitive sensory-motor training (CSMT) on the muscle strength and balance ability in post-stroke patients. METHODS: Thirty-five participants after stroke were randomly assigned to the CSMT (n = 17) or control group (n = 18). All participants received 30 min of training each time, five times per week, for six weeks. Lower extremity muscle strength of tibialis anterior (LEMTA) was evaluated using a digital muscular dynamometer. The Medical Research Council (MRC) scale was used to evaluate muscle strengths of the hip joint, knee joint, and ankle joint. For balance ability test, the center of pressure (COP) movement distance and limited of stability (LOS) were measured using BioRescue. RESULTS: LEMTA, MRC scale, balance ability were significantly more improved in the CSMT group than in the control group (p < 0.05). CONCLUSIONS: Our findings indicate that CSMT is beneficial and effective for improving muscle strength of the lower extremity and balance ability of post-stroke patients.

Effects of Kinesio Taping with Squat Exercise on the Muscle Activity, Muscle Strength, Muscle Tension, and Dynamic Stability of Softball Players in the Lower Extremities: A Randomized Controlled Study.

BACKGROUND AND PURPOSE: Knee injuries are common among female softball players, and the stability of the lower extremities and the strength of the knee are essential factors for them. The purpose of this study was to investigate the effect of Kinesio taping with squat exercise (KTSE) on lower extremity muscle activity, muscle strength, muscle tone, and dynamic stability of softball players. METHODS: In this study, 40 softball players were randomly assigned to the KTSE group and sham taping with squat exercise (SKTSE) group. All subjects were tested three times a week for 6 weeks, i.e., for a total of 18 times. To evaluate the lower-extremity muscle activity, muscle strength, and muscle tone of the lower extremities, as well as dynamic stability, we used Noraxon Mini DTS, a digital muscular meter from JTech Medical, MyotonPRO, and the side hop test (a clinical evaluation method), respectively. These items were measured before the experiment and 6 weeks after the start of the experiment. RESULTS: Both groups showed significant differences in lower-extremity muscle activity, muscle strength, muscle tone, and dynamic stability (p < 0.05). After the experiment, significant effects on lower-extremity muscle activity, muscle strength, muscle tone, and dynamic stability were observed in the KTSE group compared with in the SKTSE group (p < 0.05). CONCLUSIONS: KTSE did not have a negative effect on all items of the functional performance test. KTSE improved lower-extremity muscle activity, muscle strength, muscle tone, and dynamic stability.

Development of a Novel Controlled-Release Tablet of Pregabalin: Formulation Variation and Pharmacokinetics in Dogs and Humans.

BACKGROUND: Novel three-layered (TL) tablet systems were compared with both monolithic matrix (MM) formulations and a commercial immediate-release (IR) capsule to develop once-a-day (OAD) pregabalin tablets. METHODS: The physical properties of the TL tablets, including dissolution and swelling rates, were compared with those of the MM tablets and the pharmacokinetic parameters of the TL tablet were compared with those of an IR capsule in beagles and humans. RESULTS: Our results indicated that the same amount of a hydrophilic polymer in the formulations had similar dissolution profiles at 12 h, regardless of the tablet geometry. However, the degree of tablet swelling differed, with larger amounts of polymer in the tablets showing a greater degree of swelling. In addition, TL tablets swelled more rapidly compared with MM tablets. For the pharmacokinetic study of the TL tablet, the beagles demonstrated absorption results similar to those of an IR capsule, whereas the humans demonstrated low total absorption compared with an IR capsule. The time of the peak plasma concentration at 6 h in the fed state of humans coincided with the results of the study on beagles. CONCLUSION: The novel TL tablet system of pregabalin may prove to be helpful in developing improved formulations with better continuous drug absorption for OAD administration.

Analysis of the Effect of Backpack Design with Reduced Load Moment Arm on Spinal Alignment.

In this study, we designed a backpack that can reduce the moment arm of backpack load by placing the center of gravity of the backpack close to the axis of the spine. In order to investigate the effect of sagittal spinal alignment compared with the general backpack, we conducted the study using radiological images. The participants in this study were 18 adults (8 males and 10 females). The subjects participated in the experiment without carrying the backpack, wearing the normal backpack, and wearing a backpack designed to reduce the load moment arm by placing the center of gravity close to the body. Spinal alignment parameters were measured and analyzed using 3D radiography measurement software based on radiographic images taken under three conditions. The overall angle of lumbar lordosis, upper arc, lower arc, difference between pelvic incidence and lumbar lordosis, lower cervical lordosis, and sagittal vertical axis were measured. In the case of wearing the backpack rather than without the backpack, there was a significant difference in the overall angle of lumbar lordosis, lower arc, lower cervical spine angle, difference between pelvic incidence and lumbar lordosis, and sagittal vertical axis. In the case of wearing the backpack with reduced moment arm, the overall angle and lower arc of lumbar lordosis were significantly increased compared to those with the normal backpack. The difference between pelvic incidence and lumbar lordosis was significantly decreased. The results showed that a normal backpack caused imbalance of sagittal spinal alignment, and the backpack reducing the load moment arm by placing the backpack's center of gravity close to the vertebral joint played a positive role in reducing the change of lumbar alignment compared with the normal backpack.

Effects of Light Touch on Balance in Patients with Stroke.

Light touch is the combination of cutaneous and kinesthetic inputs. The literature suggests that light touch compensates for a reduced amount of center of pressure information in older peoples, blind subjects and patients with neurological disorder. This study investigated the effects of light touch applied to an external bar, on the postural sway in individuals with hemiparetic stroke. We used a cross sectional study, fifteen individuals with stroke and 15 healthy age-matched adults stood as still as possible on a force plate. Experimental trials (duration, 30 s) included two visual conditions (open eyes and closed eyes), two somatosensory conditions (no touch and light touch) and two support surface conditions (firm and foam surfaces). The area of center of pressure (COP) and the mean velocity of COP in the medio-lateral and anterior-posterior directions were assessed. For both groups, COP velocity and area decreased with light touch regardless of the visual or surface conditions. The effects of light touch were similar in both groups. In addition, results show that the effectiveness of light touch in reducing postural sway was greater on a foam surface than on a firm surface. Our findings indicate that light touch could be beneficial in postural control for individuals with hemi-paretic stroke.

Progressive treadmill cognitive dual-task gait training on the gait ability in patients with chronic stroke.

The purpose of this study was to investigate the effects of progressive treadmill cognitive dual-task training on gait performance in individuals with chronic stroke patients. Twenty-six participants with chronic hemiparesis were recruited to this study and randomly distributed into two groups: progressive treadmill cognitive dual-task gait training (PTCDG group, 13 patients), conventional treadmill gait training (CTG group, 13 patients). All patients underwent 20 sessions of treadmill gait training with a harness (5 times per week, for a total of 4 weeks). The GAITRite was used to analyze gait kinematics, and 10-m walking test (10MWT) wear used as the clinical evaluation indicators. After training, PTCDG group showed significant improvement in gait velocity, cadence, single support time, and 10MWT compared to the control group. However there was no significant difference between the groups in the stride lengths in the affected and unaffected sides. The study verified that progressive treadmill cognitive dual-task gait training had a positive influence on the gait and clinical gait index in chronic stroke patients.

Effects of progressive backward body weight suppoted treadmill training on gait ability in chronic stroke patients: A randomized controlled trial.

BACKGROUND AND OBJETIVE: A stroke patient with hemiplegic gait is generally described as being slow and asymmetric. Body weight-supported treadmill training and backward gait training are recent additions to therapeutic gait trainings that may help improve gait in stroke patient with hemiplegic gait. Therefore, we examined the effect of progressive backward body weight-supported treadmill training on gait in chronic stroke patients with hemiplegic gait. METHODS: Thirty subjects were divided to the experimental and control groups. The experimental group consisted of 15 patients and underwent progressive backward body weight-supported treadmill training. The control group consisted of 15 patients and underwent general treadmill gait training five times per week, for a total of four weeks. The OptoGait was used to analyze gait kinematics, and the dynamic gait index (DGI) and results of the 6-minute walk test were used as the clinical evaluation indicators. A follow-up test was carried out four weeks later to examine persistence of exercise effects. RESULTS: The experimental group showed statistically significant results in all dependent variables week four compared to the control group. However, until the eighth week, only the dependent variables, of affected step length (ASL), stride length (SL), and DGI differed significantly between the two groups. CONCLUSION: This study verified that progressive bodyweight-supported treadmill training had a positive influence on the temporospatial characteristics of gait and clinical gait evaluation index in chronic stroke patients.

Induction of apoptotic cell death by ursolic acid through mitochondrial death pathway and extrinsic death receptor pathway in MDA-MB-231 cells.

Ursolic acid (3-hydroxy-urs-12-en-28-oic acid) is a pentacyclic triterpenoid derived from leaves, berries, fruits, and flowers of medicinal plants, such as Rosemarinus officinalis. Ursolic acid has been shown to inhibit tumorigenesis, tumor promotion, and suppress angiogenesis. In our present study, we found that ursolic acid decreased cell proliferation rate and induce apoptosis in human breast cancer cell line, MDA-MB-231. When we checked the expression levels of proteins associated with apoptosis signal by using immunoblotting, we found that ursolic acid induces various apoptotic molecules related to either extrinsic or intrinsic apoptosis signal pathway in MDA-MB-231 cells. In our study, we found that ursolic acid induced the appearance of Fas receptor and cleavage of caspase-8, -3 and PARP. We also found that ursolic acid induced Bax up-regulation and Bcl-2 down-regulation and release of cytochrome C to the cytosol from mitochondria. Moreover, ursolic acid cleaved caspase-9 and decreased mitochondrial membrane potential (ΔΨm) as shown with JC-1 staining. These data indicate that ursolic acid induce apoptosis through both mitochondrial death pathway and extrinsic death receptor dependent pathway in MDA-MB-231 cells. Our data clearly indicate that ursolic acid could be used as a potential anticancer drug for breast cancer.

Relationship between group-specific component protein and the development of asthma.

RATIONALE: Airway inflammation and remodeling during asthma are attributed to the altered expression of biologically relevant proteins. OBJECTIVES: To search for asthma-specific proteins in bronchoalveolar lavage fluid (BAL) from individuals with asthma and to validate the identified proteins in an experimental model of asthma. METHODS: Liquid chromatography-tandem mass spectrometry was performed to identify proteins in BAL fluid found by two dimensional electrophoresis (2DE) to be differentially expressed in subjects with asthma versus control subjects. Group-specific component (Gc) and mRNA levels were measured using an ELISA, Western blots, and PCR. A neutralization study using an antibody against Gc protein was performed in an experimental asthma model. MEASUREMENTS AND MAIN RESULTS: Based on 2DE, 15 proteins were significantly up-regulated or down-regulated in eight subjects with asthma compared with eight control subjects. The protein levels of Gc, hemopexin, and haptoglobin-b were increased, whereas the a1- antitrypsin and glutathione S-transferase levels were decreased in subjects with asthma. The Gc concentration in BAL fluid was significantly elevated in 67 subjects with asthma compared with that in 22 control subjects (P < 0.009). The Gc was significantly correlated with the neutrophil percentage in BAL fluid of subjects with asthma (P = 0.001). Gc mRNA and protein levels were higher in ovalbumin-sensitized/ challenged asthma mice than in sham-treated mice. Gc protein were expressed on alveolar macrophages and on epithelial cells. Treatment with an anti-Gc antibody dose-dependently reduced the ovalbumin sensitization/challenge-induced enhancement of airway hyperreactivity, airway inflammation, goblet cell hyperplasia,and levels of eotaxin, interleukin-4, -5, and -13, and interferon-g. CONCLUSIONS: Gc may be involved in the development of asthma, and the neutralization of Gc protein could be a therapeutic strategy for asthma.

Role of lung apolipoprotein A-I in idiopathic pulmonary fibrosis: antiinflammatory and antifibrotic effect on experimental lung injury and fibrosis.

RATIONALE: Idiopathic pulmonary fibrosis (IPF) is caused by alterations in expression of proteins involved in multiple pathways, including matrix deposition, inflammation, injury, and repair. OBJECTIVES: To understand the pathogenic changes in lung protein expression in IPF and to evaluate apolipoprotein (Apo) A-I as a candidate therapeutic molecule. METHODS: Two-dimensional electrophoresis was adopted for differential display proteomics. Reverse-transcriptase polymerase chain reaction, Western blotting, immunohistochemical staining, and ELISA were performed for identification and quantitative measurement of Apo A-I in bronchoalveolar lavage fluids from subjects with IPF and experimental bleomycin-induced mice. MEASUREMENTS AND MAIN RESULTS: Sixteen protein spots showed differences in relative intensity between IPF (n = 14) and healthy control subjects (n = 8). Nano liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed increase of haptoglobulin and decrease of alpha(1)-antitrypsin, alpha(1)-antichymotrypsin, macrophage capping protein, angiotensinogen, hemoglobin chain B, Apo A-I, clusterin, protein disulfide isomerase A3, immunoglobulin, and complement C4A in IPF compared with normal control subjects (P = 0.006-0.044). Apo A-I concentrations were lower in bronchoalveolar lavage fluids from subjects with IPF (n = 28) than in normal control subjects (n = 18; P < 0.01). In bleomycin-treated mice, Apo A-I protein in BALF was lower than that in sham-treated control animals. Immunohistochemical analysis showed positive staining on intraalveolar macrophages and epithelial cells of the lungs. Intranasal treatment with Apo A-I protein reduced the bleomycin-induced increases in number of inflammatory cells and collagen deposition in sham-treated mice in a dose-dependent manner. CONCLUSIONS: Alterations of several inflammatory and antiinflammatory proteins in the lungs may be related to the pathogenesis of IPF, and local treatment with Apo A-I is very effective against the development of experimental lung injury and fibrosis.

Effect of safflower seeds supplementation on stimulation of the proliferation, differentiation and mineralization of osteoblastic MC3T3-E1 cells.

Anti-bone resorption properties of the Korean herbal formulation, Gami-Honghwain (HJ), which comprises Carthamus tinctorius L. seed and hominis placenta, were investigated. We demonstrate that the production of PGE2 is inhibited by 20-100 microg/ml HJ in nontransformed osteoblastic cells (MC3T3-E1 cells), indicating that HJ inhibits PGE2 production. The effect of HJ on the proliferation and osteoblastic differentiation in MC3T3-E1 was also studied. HJ dose-dependently increased DNA synthesis (significant at 20-100 microg/ml), and increased alkaline phosphatase (ALP) and prolyl hydroxylase activities of MC3T3-E1 cells (20-100 microg/ml), while anti-estrogen tamoxifen eliminated the stimulation of proliferation and ALP activity of MC3T3-E1 which was induced by HJ. These results indicate that HJ directly stimulates cell proliferation and differentiation of osteoblasts. Also, when we assessed the effects of HJ on osteoblastic differentiation in MC3T3-E1, HJ enhanced ALP activity and mineralization in a dose- and time-dependent fashion. This stimulatory effect of the HJ was observed at relatively low doses (significant at 20-100 microg/ml and maximal at 100 microg/ml). Northern blot analysis showed that the HJ (60 microg/ml) increased in bone morphogenetic protein-2 as well as ALP mRNA concentrations in MC3T3-E1 cells. HJ (100 microg/ml) slightly increased in type I collagen mRNA abundance throughout the culture period, whereas it markedly inhibited the gene expression of collagenase-1 between days 15 and 20 of culture. These results indicate that HJ has anabolic effect on bone through the promotion of osteoblastic differentiation, suggesting that it could be used for the treatment of common metabolic bone diseases.

Proteomic identification of macrophage migration-inhibitory factor upon exposure to TiO2 particles.

Inhalation of particulate matter aggravates respiratory symptoms in patients with chronic airway diseases, but the mechanisms underlying this response remain poorly understood. We used a proteomics approach to examine this phenomenon. Treatment of epithelial cells with BSA-coated titanium dioxide (TiO(2)) particles altered 20 protein spots on the two-dimensional gel, and these were then analyzed by nano-LC-MS/MS. These proteins included defense-related, cell-activating, and cytoskeletal proteins implicated in the response to oxidative stress. The proteins were classified into four groups according to the time course of their expression patterns. For validation, RT-PCR was performed on extracts of in vitro TiO(2)-treated cells, and lung issues from TiO(2)-treated rats were analyzed by immunohistochemical staining and enzyme immunoassay. TiO(2) treatment was found to increase the amount of mRNA for macrophage migration-inhibitory factor (MIF). MIF was expressed primarily in epithelium and was elevated in lung tissues and bronchoalveolar lavage fluids of TiO(2)-treated rats as compared with sham-treated rats. Carbon black and diesel exhaust particles also induced expression of MIF protein in the epithelial cells.